The past 30 years have brought remarkable change in the evolution of ACL surgery. Surgeons have recognized the important role of the ACL and developed techniques for its reconstruction. As these techniques evolved, certain themes echo throughout the historical literature. Dynamic, nonisometric operations have not worked well, nor have synthetic substitutes. Perhaps most importantly, the more anatomic the reconstruction, the better it was able to restore patient function and the more predictable the result. Technological advances allowed these techniques to be refined so that they are now routinely performed with less tissue trauma, faster recovery, and reproducibly excellent results. This article reviews the historical surgical progress that has evolved coupled with overlapping controversies and concepts, which have impacted surgical changes.
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